Evaluation of the Nutritional Quality with Healthy Eating Index in Patients of Bariatric Surgery

Abstract

Aim: The objective of this study is to evaluate the diet quality of bariatric surgery patients using the Healthy Eating Index (HEI). Material and Methods: The research was conducted between November 2018 and March 2019, involving a total of 44 voluntary individuals who had undergone Sleeve Gastrectomy (SG) for a minimum of 3 months, with 75% being female and 25% male. A face-to-face interview method with a survey form consisting of 40 questions was utilized to collect data. The individuals' diet quality was assessed using the Healthy Eating Index-2010 (HEI-2010). Results: The mean total HEI score was 62.15±6.13, with no gender-based differences observed (p=0.586). According to HEI subgroups, individuals consumed dairy, protein, vegetables, and fruits with high diet quality, whereas whole grain consumption reflected lower diet quality. Post-surgery, those receiving nutritional support had a higher median score for total vegetable consumption and a lower score for fatty acid intake (p=0.038, p=0.019). The average daily energy intake for females was 963.2±134 kcal, with a protein intake of 45.2±9.1 g, while for males, these figures were 1049.8±121.5 kcal and 53.5±5.3 g, respectively. Daily protein intake was found to be significantly higher in males (p=0.007). Both genders exhibited insufficient daily intake of folate, vitamin D, and thiamine. Daily intake levels of calcium, folate, and sodium were observed to be higher in males, while zinc intake was higher in females (p<0.05). According to the HEI, one patient demonstrated good diet quality, while 43 patients were found to need improvements. Conclusion: Post-bariatric surgery, maintaining good diet quality is important for predicting nutrient deficiencies. This study revealed that the diet quality of sleeve gastrectomy patients is not poor but could benefit from improvement. Conducting larger-scale studies involving the Healthy Eating Index within a broader population can contribute to healthier weight management and improved diet quality for bariatric surgery patients.

Keywords

• bariatric surgery
• diet quality
• sleeve gastrectomy
• Healthy Eating Index
• Obesity

Bariatrik Cerrahi Hastalarının Sağlıklı Yeme İndeksi ile Diyet Kalitelerinin Değerlendirilmesi

Abstract

Amaç: Bu çalışmada, Sağlıklı Yeme İndeksi (SYİ) ile bariatrik cerrahi hastalarında diyet kalitelerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Araştırma Kasım 2018 – Mart 2019 tarihlerinde Sleeve Gastrektomili (SG), en az 3 ayını doldurmuş, toplam 44 (%75’i kadın, %25’i erkek) gönüllü birey üzerinde 40 sorudan oluşan anket formu ile yüz yüze görüşme yöntemiyle yapılmıştır. Bireylerin diyet kaliteleri Sağlıklı Yeme İndeksi-2010 ile değerlendirilmiştir. Bulgular: SYİ toplam puan ortalaması 62,15±6,13’tür ve cinsiyetler arasında farklılık görülmemiştir (p=0,586). SYİ alt gruplarına göre süt, protein ve sebze, meyve grubu yiyecekleri yüksek diyet kalitesinde ve tam tahıllı yiyecekleri ise düşük diyet kalitesinde tükettikleri saptanmıştır. Cerrahi sonrasında beslenme desteği alanların diyet kalitesinde toplam sebze puan ortancası, beslenme desteği almayanlardan daha yüksek; yağ asitleri puanı ise daha düşük bulunmuştur (p=0,038, p=0,019). Kadınların günlük enerji alım ortalaması 963,2±134 kkal, protein alımı 45,2±9,1 g iken erkeklerin sırasıyla 1049,8±121,5 kkal ve 53,5±5,3 g olarak bulunmuştur. Erkek bireylerin günlük protein alım miktarı kadınlardan istatistiksel olarak önemli fazla saptanmıştır (p=0,007). Her iki cinsiyette folat, D vitamini ve tiamin günlük alımının yetersiz olduğu saptanmıştır. Günlük kalsiyum, folat, sodyum alım düzeyinin erkeklerde; çinko alım düzeyinin ise kadınlarda daha fazla olduğu belirlenmiştir (p<0,05). SYİ’ye göre 1 hastanın da iyi diyet kalitesine ve 43 hastanın geliştirilmesi gereken diyet kalitesine sahip olduğu belirlenmiştir. Sonuç: Bariatrik cerrahi sonrası iyi diyet kalitesi besin öğesi yetersizliklerinin öngörülmesinde önemlidir. Bu araştırmada, sleeve gastrektomili hastaların diyet kalitelerinin kötü olmadığı ancak geliştirilmesi gerektiği saptanmıştır. Daha geniş popülasyonda sağlıklı yeme indeksiyle yürütülecek çalışmalar, bariatrik cerrahi hastalarında sağlıklı vücut ağırlığı kontrolü ve diyet kalitesinin iyileştirilmesinde fayda sağlayacaktır.

Keywords

• bariatrik cerrahi
• diyet kalitesi
• sleeve gastrektomi
• sağlıklı yeme indeksi
• obezite

References

1. Who.int [Internet]. Obesity. Erişim Tarihi: 17.11.2022. https://www.who.int/health-topics/obesity#tab=tab_1.
2. oecd-ilibrary.org [Internet]. Obesity among adults. Erişim Tarihi: 17.11.2022. https://www.oecd-ilibrary.org/sites/8cdeadfa-en/index.html?itemId=/content/component/8cdeadfa-en.
3. Yüksel A. Bariatrik cerrahi operasyonu geçiren morbid obez bir hastanın 3 yıl sonraki beslenme durumu : olgu sunumu. İzmir Kâtip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 2016; 1(1): 39-45.
4. Buchanan K, Sheffield J. Why do diets fail? an exploration of dieters’ experiences using thematic analysis. J Health Psychol. 2017; 22(7): 906-15. https://doi.org /10.1177/1359105315618000.
5. Polat, P. Bariyatrik cerrahi sonrasi hastalarin yeme tutum ve davranişlari ile diyete uyumları. MS thesis. Sağlık Bilimleri Enstitüsü. Marmara Üniversitesi. 2018.
6. Erdem NZ, Bariatrik cerrahide beslenme durumunun değerlendirilmesi, beslenme desteği ve ı̇zlenmesi. İçinde: Tüfekçi Alphan E, editör. Hastalıklarda Beslenme Tedavisi. İstanbul, Hatiboğlu 2017; 295- 8.
7. Jastrzebska-Mierzyiska M, Ostrowska L, Razak Hady H, Dadan J, Konarzewska-Duchnowska E. The impact of bariatric surgery on nutritional status of patients. Videosurgery and Other Miniinvasive Techniques. 2015; 10(1): 115-24. https://doi.org/10.5114/wiitm.2014.47764
8. Toninello P, Montanari A, Bassetto F, Vindigni V, Paoli, A. Nutritional support for bariatric surgery patients: the skin beyond the fat. Nutrients. 2021; 13(5): 1565. https://doi.org/10.3390/nu13051565.

9. Kafri N, Valfer R, Nativ O, Shiloni E, Hazzan D. Health behavior, food tolerance, and satisfaction after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2011; 7(1): 82-8. https://doi.org/10.1016/j.soard.2010.09.016.
10. Erçim RE, Pekcan G. Genç yetişkinlerin beslenme durumunun sağlıklı yeme indeksi-2005 ile değerlendirilmesi. Beslenme ve Diyet Dergisi. 2014; 42(2): 91-8.
11. Ertuglu LA, Demiray A, Afsar B, Ortiz A, Kanbay M. The use of healthy eating index 2015 and healthy beverage index for predicting and modifying cardiovascular and renal outcomes. Curr Nutr Rep. 2022; 11(3): 526-35. https://doi.org/10.1007/s13668-022-00415-2.
12. Morze J, Danielewicz A, Hoffmann G, Schwingshackl L. Diet quality as assessed by the healthy eating index, alternate healthy eating index, dietary approaches to stop hypertension score, and health outcomes: a second update of a systematic review and meta-analysis of cohort studies. J Acad Nutr Diet. 2020; 120(12): 1998-2031. https://doi.org/10.1016/j.jand.2020.08.076
13. Da Silva FBL, Gomes DL, de Carvalho KMB. Poor diet quality and postoperative time are independent risk factors for weight regain after Roux-en-Y gastric bypass. Nutrition. 2016; 32(11–12): 1250-3. https://doi.org/10.1016/j.nut.2016.01.018.
14. Jabbour J, Awada D, Naim N, Al-Jawaldeh A, Haidar Ahmad H, Mortada H, et al. Impact of bariatric surgery on the healthy eating ındex, binge eating behavior and food craving in a middle eastern population: a lebanese experience. Healthcare (Basel). 2021; 9(11): 1416. https://doi.org/10.3390/healthcare9111416
15. Pekcan G. Beslenme Durumunun Saptanması. Diyet El Kitabı. Ankara, Hatiboğlu Yayınevi. 2008: 67-141.
16. Parrott, J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American society for metabolic and bariatric surgery ıntegrated health nutritional guidelines for the surgical weight loss patient 2016 update : micronutrients. Surg Obes Relat Dis. 2017; 13(5): 727-41. https://doi.org/10.1016/j.soard.2016.12.018. Epub 2017 Jan 19.
17. Guenther PM, Kirkpatrick SI, Reedy J, Krebs-Smith SM, Buckman DW, Dodd KW, et al. The healthy eating index-2010 is a valid and reliable measure of diet quality according to the 2010 dietary guidelines for Americans. J Nutr. 2014; 144(3): 399-407. https://doi.org/10.3945/jn.113.183079
18. Avenell A, Broom J, Brown T, Poobalan A, Aucott L, Stearns SC, et al.Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Asses. 2004; 8(21): 1-182. https://doi.org/10.3310/hta8210
19. Barros, LM, Frota NM, Moreira RAN, Araujo TMD, Caetano JA. Assessment of bariatric surgery results. Revista gaucha de enfermagem. 2015; 36(1): 21-7. https://doi.org/10.1590/1983-1447.2015.01.4769 .
20. Sieber P, Gass M, Kern B, Peters T, Slawik M, Peterli R. Five-year results of laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014; 10(2): 243-9. https://doi.org/10.1016/j.soard.2013.06.024.
21. Anuk T, Köksal N, Avşar F, Allahverdi TD, Sülü B, Çakmur H. Bariatrik cerrahi ile ilgili ilk sonuçlarımız. Ege Tıp Derg. 2017; 56(2): 82-5. https://doi.org/10.19161/etd.344245.
22. Kanerva N, Larsson I, Peltonen M, Lindroos AK, Carlsson LM. Sociodemographic and lifestyle factors as determinants of energy intake and macronutrient composition: a 10-year follow-up after bariatric surgery. Surg Obes Relat Dis. 2017; 13(9): 1572-83. https://doi.org/10.1016/j.soard.2017.05.025
23. McGrice MA, Porter JA. What are gastric banding patients eating one year post-surgery? Obes Surg. 3012; 22(12): 1855-8. https://doi.org/10.1007/s11695-012-0741-x .
24. Aills L, Blankenship J, Buffington C, Furtado M, Parrott J. ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. Surg Obes Relat Dis. 2018; 4(5): S73-S108. https://doi.org/10.1016/j.soard.2008.03.002.
25. Sabuncu T (ed). Bariyatrik Cerrahi Kılavuzu, Obezite, Lipid Metabolizması, Hipertansiyon Çalışma Grubu, Türkiye Endokrinoloji ve Metabolizma Derneği, ISBN: 978-605-4011-28-5, 2019;59.
26. Kuyucu A. Bariatrik cerrahi uygulanmış hastaların ameliyat sonrası altı ay ve üzeri sürede vücut ağırlığı kaybının, besin tüketim durumunun ve bazı biyokimyasal bulgularının belirlenmesi. Hasan Kalyoncu Üniversitesi. 2018;1-96. https://hdl.handle.net/20.500.11782/1724
27. Müftüoğlu S, Küçükağdaş Ş. Bariatrik cerrahi sonrası bireylerin iştah kontrolü ve yeme bağımlılıklarının değerlendirilmesi. Bes Diy Derg. 2019; 47(2): 30-9. https://doi.org/10.33076/2019.BDD.1156.
28. Hansen D, Decroix L, Devos Y, Nocca D, Cornelissen V, Dillemans B, et al. Towards optimized care after bariatric surgery by physical activity and exercise intervention: a review. Obes Surg. 2020; 30(3): 1118-25. https://doi.org/10.1016/j.metabol.2018.09.005
29. Santos C, Carvalho M, Oliveira L, Palmeira A, Rodrigues LM, Gregório J. The long-term association between physical activity and weight regain, metabolic risk factors, quality of life and sleep after bariatric surgery. Int J Environ Res Public Health. 2022; 19(14): 8328. https://doi.org/10.3390/ijerph19148328
30. FanY, Zhang Y, Li J, Liu Y, Zhou L, Yu Y. Association between Healthy Eating Index-2015 and physical frailty among the United States elderly adults: The National Health and Nutrition Examination Survey (NHANES) 2011–2014. Aging Clin Exp Res. 2021; 33(12): 3245-55. https://doi.org/10.1007/s40520-021-01874-3.
31. Fan Y, Zhang Y, Li J, Liu Y, Chang H, Jiang Y, et al. Association between healthy eating index-2015 and various cognitive domains in US adults aged 60 years or older: the National Health and Nutrition Examination Survey (NHANES) 2011-2014. BMC Public Health. 2021; 21(1): 1862. https://doi.org/10.1186/s12889-021-11914-2.
32. Giusti V, Theytaz F, Di Vetta V, Clarisse M, Suter M, Tappy L. Energy and macronutrient intake after gastric bypass for morbid obesity: a 3-y observational study focused on protein consumption. Am J Clin Nutr. 2016; 103(1): 18-24. https://doi.org/10.3945/ajcn.115.111732 .
33. Verger EO, Aron-Wisnewsky J, Dao MC, Kayser BD, Oppert JM, Bouillot JL, et al. Micronutrient and protein deficiencies after gastric bypass and sleeve gastrectomy: a 1-year follow-up. Obes Surg. 2016; 26(4): 785-96. https://doi.org/10.1007/s11695-015-1803-7.
34. Schweiger C, Weiss R, Keidar A. Effect of different bariatric operations on food tolerance and quality of eating. Obes Surg. 2010; 20(10): 1393-9. https://doi.org/10.1007/s11695-010-0233-9.
35. Moize V, Andreu A, Flores L, Torres F, Ibarzabal A, Delgado S, et al. Long-term dietary intake and nutritional deficiencies following sleeve gastrectomy or roux-en-y gastric bypass in a mediterranean population. J Acad Nutr Diet. 2013; 113(3):400-10. https://doi.org/10.1016/j.jand.2012.11.013
36. Calleja-Fernandez A, Pintor-De-La-Maza B, Díez-Rodriguez R, Vidal-Casariego A, Urioste-Fondo A, Cano-Rodriguez I, et al. Short-term changes in macronutrient intake in morbidly obese patients undergoing biliopancreatic diversion: a longitudinal study. Nutr Hosp. 2015; 32(1): 87-93. https://doi.org/10.3305/nh.2015.32.1.9012
37. Kruseman M, Leimgruber A, Zumbach F, Golay A. Dietary, weight, and psychological changes among patients with obesity, 8 years after gastric bypass. J Am Diet Assoc. 2010; 110(4): 527-34. https://doi.org/10.1016/j.jada.2009.12.028.
38. Coluzzi I, Raparelli L, Guarnacci L, Paone E, Del Genio G, le Roux CW, et al. Food ıntake and changes in eating behavior after laparoscopic sleeve gastrectomy. Obes Surg. 2016; 26(9): 2059-67. https://doi.org/10.1007/s11695-015-2043-6.
39. Martindale RG, Warren M, Kiraly L. Nutrition support in bariatric surgery. Curr Surg Rep. 2015; 3(10): 30. https://doi.org/10.1007/s40137-015-0108-z.
40. Aills L, Blankenship J, Buffington C, Furtado M, Parrott J. Allied Health Sciences Section Ad Hoc Nutrition Committee. ASMBS allied health nutritional guidelines for the surgical weight loss patient. Surg Obes Relat Dis. 2008; 4(5 Suppl): 73-108. https://doi.org/10.1016/j.soard.2008.03.002.
41. Jandari S, Mosalmanzadeh N, Moghadam MRSF, Soleimani D, Shivappa N, Hebert JR, et al. Dietary inflammatory index and healthy eating index-2015 are associated with rheumatoid arthritis. Public Health Nutr. 2021; 24(18): 6007-14. https://doi.org/10.1017/S1368980021001105.
42. Fan Y, Ni S, Zhang H. Association between Healthy Eating Index-2015 total and component food scores with osteoporosis in middle-aged and older Americans: a cross-sectional study with U.S. National Health and Nutrition Examination Survey. Osteoporos Int. 2022; 33: 921-9. https://doi.org/10.1007/s00198-021-06247-0
43. Shah M, Adams-Huet B, Rao S, Snell P, Quittner C, Garg A. The effect of dietary counseling on nutrient ıntakes in gastric banding surgery patients. J Investig Med. 2016; 61(8): 1165-72. https://doi.org/10.2310/jim.0000000000000002.